ASHP - Even Smaller Fees, but Not "Global"

By Editorial Staff

In an apparent response to the immediate dissatisfaction of its members, the American Specialty Health Plans (ASHP) has decided not to implement its $30 "global fee."1 This charge was scheduled to begin August 1, but a July 27 notice to chiropractic providers presented the following fee schedule:

Initial Examination: $30 The initial examination will be allowed without authorization.

Office Visit/Treatment: $26 The office visit reimbursement will be $26, which will include reimbursement for all services associated with the office visit and treatment, including a brief re-evaluation, manipulation and adjunctive therapeutic modalities and procedures. Adjunctive therapies will no longer be reimbursed separately, but will be included under the office visit or treatment.

X-rays, Clinical Laboratory Service and Chiropractic Appliance: No change in reimbursement.

These new per diem rates (as they are being referred to by ASHP) include the co-payments, which "will be deducted from the amount to be paid by ASHP." Services covered by this per diem reimbursement include all those contained in the office visit or treatment schedule. ASHP fee schedule notes that "reimbursement of these services will be at these rates or 80% of the billed amount, whichever is less." This means that the amount billed will have to be higher to receive the full amount of the new reimbursement rates. These fees apply to ASHP only, not to American Specialty Health Networks.

The new $26 per diem rate is more than a 30 percent drop from the $38 paid last year. The per diem designation still harbors the "specter" of a global fee sometime in the future. When comparing the new per diem reimbursement rate with the rescinded $30 global rate announced on July 5, the new fee structure rewards those DCs who only see a patient seven visits or less, unless authorization is obtained for a re-examination. Even this would only help offset the additional $4 (the difference between the $30 and the $26) reduction in reimbursement for an additional five visits.

No matter how you do the math, ASHP providers continue to see a dramatic reduction in reimbursement rates, leaving many DCs to wonder just how they can continue to accept these terms.

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